| NPI | 1477765451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX G9930) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX G9930) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2007-07-08 |